„HRV in the air”:

What data from top gun pilots tells us

about physical and mental workload?

COL Sándor (Alex) András SZABÓ, MD, PhD, DAvMed (UK)

Chief Flight Surgeon of Hungarian Defence Forces

Hornyik, J. , Vada, G., Szabó, S., Dunai, P.

GINOP-2.3.2-

15-2016-00007

„in service

of nation”

National University for Public Servants

MEDICAL CENTER OF HUNGARIAN

DEFENCE FORCES, KECSKEMÉT

Military service job (especially flight) is

really challenging for almost every soldier (including special forces):

the excessive energy demands (both physically and mentally) caused

by special deployments and missions

can provoke autonomic imbalance,

POSSIBLE ROLE in acute incapacitation

characterized by a hyperactive sympathetic system and a hypoactive

parasympathetic system which finally can lead to premature aging and

diseases.

AEROMEDICAL STRESSORS

accelerations - overloads

hypo / hyperthermia

noise

vibration

motion sickness

spatial disorientation

hypoxia

Ionizing and high

frequency radiation

BEYOND THE CURVE … - INFORMATION WAR

Brig. Gen. Dr. Erich Rödig, German Air Force

2nd USER MEETING ZAGRAB, 2009. szeptember 4-6.Time (years)

WO

RK

LO

AD

▪ ambulatory & real Holter ECG

▪ hypoxic tolerance exams

▪ orthostatic tolerance measurements

▪ Pressure breathing tests

▪ GYRO lab simulator

▪ centrifuge runs

AEROMEDICAL FUNCTIONAL DIAGNOSTIC

EXAMINATIONS

hypoxia psychic stress

physical stress

accelerations

vibration

vegetative dystonia in CNS change in perfusion

hypoxaemia

CO, ectopic activity, myocardium depression

Neurohumoral activation

Aeromedical aspects

1st Lt. Lea ZOLNAI

1st female transport pilot on A319

Stress tolerance ? Mind set vs. skill set ?

Ground-based

simulationReal Flight ?

Psychology

Cognitive test battery

Virtual Reality ?

Barochamber +

Cognitive test battery

Barochamber +

Virtual Flight

LAB into REAL WORLD !

FIRSTBEAT BODYGUARD2 – FUSION VITAL

eddigi eredmények, tervezett kutatási irányok

1. Rendszerként - egyszerű technikai alkalmazhatóság,

telepíthetőség, beolvasás

2. Szoftverként - könnyű értékelhetőség, grafikon szerkesztés

splitterek segítségével

3. Környezeti ellenállóképesség - hypoxia, G túlterhelés (G szenzor)

4. VR/VE technológiával széleskörű repülésélettani szimulációs

alkalmazhatóság

5. Valós repülés – monitorizálás?? Orvosi feketedoboz??

6. Pszichés trauma (katapultálás) – regeneráció?

7. Pilóta munkával járó stressz jellemzése

FIRSTBEAT BODYGUARD2 – FUSION VITAL

USING FIRSTBEAT BODYGUARD2

in military aviation research project

1. As a system – simple deployable

2. As a software –straightforward evaluation, edition of graphs with splitters

3. Durability - hypoxia, G loads (G sensor up to 9 Gz-s)

4. Simulation - +VR/VE technology –

5. Real flight – monitoring system (with synchronized

data?)

6. Psychic trauma (ejection – regeneration/recovery?)

7. Pilot work related stress (mental or physiological)

The Canadian Armed Forces (CAF) is undertaking a major research initiative with the help

of Firstbeat Lifestyle Assessment. Dr. Julie Martin of the Directorate Fitness Team is

overseeing the study that will use real-world measurement data

investigate the physiological impact of participant’s daily life

and will be used to better understand fitness related topics

across the CAF. (2017. March)

Canadian Armed Forces Fitness Study

F/U 2-6 days!

Mansikka, H, Simola, P, Virtanen, K, Harris, D, Oksama, L: Fighter pilots'

heart rate, heart rate variation and performance during instrument

approaches. Ergonomics. 2016 Oct; 59(10):1344-1352. Epub 2016 Mar 4

(The study was coordinated and funded by the Finnish Defence Research

Agency) – „more complex fighter aviation scenario”

FINNISH AIR FORCE – „hi-fi” simulator study

EU GINOP PROJECT: NIRS + VR

NIRS: Near Infrared Spectroscopy

VR: Virtual Reality

JAS-39 Aircrew Equipment Assembly

Oxygen Mask

127B

Anti-g Garment

97C/K

Type 116E Helmet

Survival Jacket 39

Gripen Boots

FIRSTBEAT

BODYGUARD2

FIRSTBEAT BODYGUARD2

GRIPEN fighter pilot’s working dayFlight sortie:

1. Low altitude target flight for interception 2x

2. Aerobatics up to 9 Gz

?

Strongest

stress

response

Conditioning

effectIntensive

recovery

FLIGHT: 1. Low altitude target flight for interception 2x

2. Aerobatics up to 9 Gz

FIRSTBEAT BODYGUARD2

GRIPEN fighter pilot’s working day –training flight sortie

Strongest

stress

response

Strongest

stress

responseNo recovery

FIRSTBEAT BODYGUARD2

GRIPEN fighter pilot’s working day –preparation day with gym

stress response / calorie expenditure

Conditioning

effect Strongest

stress

responseNo recovery

Paratrooper jumps

3500 & 600 m

FIRSTBEAT BODYGUARD2

paratrooper’s working day

HR decrease, RMSSD and LF/HF increase during training. Krzysztof Mazurek, K.,Nawoja Koprowska N., Jan Gajewski, J.,

Zmijewski, P., Franciszek Skibniewski, F., Rózanowski, K.: Parachuting training improves autonomic control of the heart in

novice parachute jumpers. Biocybernetics and Biomedical Engineering · December 2017, DOI: 10.1016/j.bbe.2017.11.004,

www.sciencedirect.com

Conditioning

effectIntensive

recoverySlightly

weakened

recovery

Lifestyle assessment (own registration)

PULSE TREND and HRV in Low pressure Chamber

(5 500 m VR flight)

Strongest

stress

response No recovery

LPC run from 11:22,

simulated ER from 11:37

(18 000 feet, hypoxia)

descent to 3000 m,

oxygen from 11:40

Dr Szabó Stressz és a repülés

PULSE TREND and HRV

on working day,

in Low pressure Chamber

(3 500 m, 30 min, VR flight) Strongest

stress response

Intensive

recovery ??

11: 15

Lifestyle assessment (own registration)

Body resources

Decline in body resources

PULSE TREND and HRV in Low pressure Chamber

(5 500 m VR flight)

ANS IMBLANCE - LOWEST VALUES – LARGER BURDEN

HR / HRV average during LPC flight

HR avg (bpm) HRV (RMSSD) avg (msec)

oxygenation

hypocapnia

100 % oxygen

WHO WE REALLY NEED ?

ROLAND GARROS

„GAMER”„MAVERICK”

1. continuous exhaustive military training flight missions or paratrooper’s

jump sorties - destabilized vegetative tone with increased arousal and

finally can lead to psychosomatic effects of fatigue or even burnout.

2. lifestyle assessment of pilot / experienced paratrooper - compare the

real burden caused by military mission / (civil airline flights?) and regular

military physical activity and the possible recovery after sorties.

Individual reactions!

3. Combined effects of hypoxia and Virtual Reality flight can be studied in

ground-based simulation settings in barochamber or the mental effort

related to combined aeromedical psychometric test batteries can be

monitorized as well.

4. AI (machine) vs MAN – who has the final decision? Real time monitoring

and BIG DATA : HRV, + NIRS , + EEG

CONCLUSIONS